Psychological health in patients with genital and oral erosive lichen planus

BACKGROUND: Erosive lichen planus is a severe, recurrent and recalcitrant disease that affects several mucosal areas, mostly the genital area and the mouth, but also, for example, the oesophagus and perianal area. The disease causes serious symptoms, because of the raw, de-epithelialized mucosa and healing with scars/adhesions, which affect the patient's life in many ways. It causes, for example, difficulties in eating, drinking and going to the bathroom. Treatment is complicated and, so far, few therapeutic drugs other than steroids have been reported. OBJECTIVES: As the disease has severe implications on the patient's life it is important to investigate the psychological health of the patients, as well as the influence of stress on their health and wellbeing, in order to improve treatment. STUDY DESIGN, SUBJECTS AND METHODS: Forty-nine consecutive patients with erosive lichen planus were included during a 1-year period. The study was carried out as 'state-of-the-last-month', and stress, state anxiety, depression and 'erosive lichen planus factors', i.e. symptoms affecting daily life, were assessed. RESULTS: Eighty-seven per cent of the patients had symptoms, severely affecting daily life. Unexpectedly, oral symptoms seemed to be the most prominent. Our results showed that depression, anxiety and stress were more common in patients with erosive lichen planus than in a control group. DISCUSSION AND CONCLUSIONS: Erosive lichen planus is a severe disease with symptoms and complications affecting the patient's life. Our results indicate that their psychological health is also affected and emphasize the need for close collaboration between physicians, dentists with special knowledge in oral medicine and counsellors/psychologists to optimize handling of these patients.     

Profound decrease of in vivo formation of thromboxane during oestrogen therapy

Oestrogen has been proposed to influence platelet activity and formation of the vasoactive eicosanoids thromboxane and prostacyclin. Previous studies have been based on ex vivo techniques with well-known artifacts during blood sampling and ex vivo conditions. The present study is the first to assess in vivo formation through gas chromatographic/mass spectrometric analysis of the major urinary metabolites 2,3-dinor-thromboxane B₂ and 2,3-dinor-6-keto-PGF_1α. Ten consecutive male patients with prostatic carcinoma participating in a randomized study comparing the effects of parenteral oestrogen therapy ( n =5) with orchidectomy ( n =5) were included. Oestrogen was given as polyestradiol phosphate 240 mg i.m. every month. 2,3-dinor thromboxane B₂ and 2,3-dinor-6-keto-PGF_1α were analysed with the help of tetradeuterated internal carriers/standards. We found a consistent decrease of in vivo formation of thromboxane by ≈40% during parenteral oestrogen therapy ( P =0.008) and a doubling after surgical castration. The ratio of prostacyclin to thromboxane increased by ≈50% ( P =0.023) during oestrogen therapy. In conclusion, oestrogen induced a marked decrease of in vivo formation of thromboxane and a marked increase in the ratio of prostacyclin to thromboxane formation in all patients. According to current knowledge this should be beneficial for the cardiovascular system. Furthermore, thromboxane formation increased after surgical castration. The latter fact should direct attention to the influence of androgens on thromboxane synthesis. Our findings discloses a marked sex-hormone sensitivity of the thromboxane-forming system.     

The value of local registry data for describing cervical cancer management and outcomes over three decades in Australia

Registry data on invasive cervical cancers (n = 1,274) from four major hospitals (1984‐2012) were analysed to determine their value for informing local service delivery in Australia. The methodology comprised disease‐specific survival analyses using Kaplan‐Meier product‐limit estimates and Cox proportional hazards models and treatment analyses using logistic regression. Five‐ and 10‐year survivals were 72% and 68%, respectively, equating with relative survival estimates for Australia and the USA. Most common treatments were surgery and radiotherapy. Systemic therapies increased in recent years, generally with radiotherapy, but were less common for residents from less accessible areas. Surgery was more common for younger women and early‐stage disease, and radiotherapy for older women and regional and more advanced disease. The proportion of glandular cancers increased in‐step with national trends. Little evidence of variation in risk‐adjusted survival presented over time or by Local Health District. The study illustrates the value of local registry data for describing local treatment and outcomes. They show the lower use of systemic therapies among residents of less accessible areas which warrants further investigation. Risk‐adjusted treatment and outcomes did not vary by socio‐economic status, suggesting equity in service delivery. These data are important for local evaluation and were not available from other sources.     

Congenital chylothorax in siblings

We describe two cases of congenital chylothorax in siblings with important differences from previously described familial cases. Our findings support the likelihood of an autosomal recessive inheritance in some cases of this condition, rather than X-linked recessive inheritance, which has also been suggested. Autopsy findings from one of these cases and others previously described suggest that the pathophysiological mechanisms involved may be variable.     

Effect of atrial natriuretic factor on renal prostaglandin E2 release in the anaesthetized dog

Experiments were undertaken in two groups of barbiturate anaesthetized dogs to examine whether atrial natriuretic factor (ANF) exerts an effect on renal release of prostaglandin E₂ (PGE₂). In the first group, intravenous infusion of ANF (50 ng min^-1kg^-1body wt) reduced basal PGE₂ release from 4.4 ± 0.8 pmol min^-1to 1.8 ± 0.7 pmol min^-1. In the second group, intrarenal infusion of an α-adrenoceptor agonist, phenylephrine (2.5–6.75 μg min^-1), raised PGE₂ release from 2.7 ± 0.5 pmol min^-1to 7.5 ± 1.3 pmol min^-1. During continuous α₁-adrenergic stimulation, intravenous infusion of ANF (100 ng min^-1kg^-1body wt) reduced PGE₂ release to 3.5 ± 1.0 pmol min^-1. These results demonstrate that ANF reduces basal and α₁-adrenergic stimulated renal PGE₂ release.     

Baroreflex improvement in shr after ace inhibition involves angiotensin-(1-7)

ACE inhibitors are extensively used in the treatment of hypertension mainly because of their efficiency in reducing blood pressure levels and decreasing vascular and cardiac hypertrophy. In addition, ACE inhibitors improve baroreceptor reflex control. Chronic inhibition of ACE produces (in addition to decreased angiotensin II levels) a severe increase in angiotensin-(1-7) [Ang-(1-7)] levels in several species. We have previously shown that Ang-(1-7) produces a facilitation of the baroreflex control of heart rate. In this study, we evaluated the participation of endogenous Ang-(1-7) in the improvement of baroreflex sensitivity in spontaneously hypertensive rats after central infusion of ramiprilat, an ACE inhibitor. Reflex changes in heart rate were elicited, in conscious rats, by bolus injections of phenylephrine (baroreflex bradycardia) before and after intracerebroventricular infusion of (1) saline (8 microL/h), 4 hours (n=5); (2) ramiprilat (14 microg/h), 4 hours (n=6); (3) ramiprilat for 2 hours, followed by ramiprilat combined with A-779 (4 microg/h), a selective Ang-(1-7) antagonist, for an additional 2 hours (n=6); and (4) A-779 for 2 hours, followed by A-779 combined with ramiprilat for an additional 2 hours (n=5). Intracerebroventricular infusion of ramiprilat produced an important increase ( approximately 40%) in baroreflex sensitivity (evaluated as the ratio between changes in heart rate and changes in mean arterial pressure) that was completely reversed by A-779. Furthermore, intracerebroventricular infusion of A-779 prevented the improvement of the baroreflex sensitivity produced by ramiprilat. Intracerebroventricular infusion of saline or A-779 alone did not significantly alter the baroreflex sensitivity. These results suggest that endogenous Ang-(1-7) is involved in the improvement of baroreflex sensitivity observed in spontaneously hypertensive rats during central ACE inhibition.     

RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症的有效性探究

目的：探讨RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症伴腰椎不稳的临床效果。方法将本院2011年9月~2013年9月收治的44例腰椎间盘突出症伴腰椎不稳患者按不同手术治疗方案随机分为对照组21例和观察组23例,对照组采用髓核摘除＋经后路关节突单纯植骨融合手术治疗,观察组采用RSS椎弓根钉内固定＋植骨融合手术治疗,比较两组的围术期情况、JOA评分、植骨融合情况。结果两组的手术耗时、术中出血量及住院时间比较差异无统计学意义（P〉0.05）。两组术后6个月的JOA评分均明显高于术前（P〈0.05）;观察组术后6个月的JOA评分高于对照组（P〈0.05）。两组植骨融合成功率比较差异有统计学意义（P〈0.05）。结论RSS椎弓根钉内固定结合植骨融合治疗腰椎间盘突出症伴腰椎不稳具有植骨融合率高、远期恢复效果显著等优点,值得临床推广应用。     

自血混合丙球穴位注射对哮喘豚鼠肺超微结构变化的观察

目的与方法　利用透射式电子显微镜观察自血混合丙球穴位注射对过敏性哮喘豚鼠肺超微结构变化情况。结果　丙球穴注组豚鼠肺组织内EOS、纤维组织减少;自血穴注组比丙球穴注组疗效好,而自血混合丙球穴注组过敏性豚鼠肺组织内EOS基本消失,基底膜无增厚,胶原纤维无增生,镜下观察与正常组基本无区别。结论　自血混合丙种球蛋白穴位注射治疗哮喘有可靠的超微结构依据。     

Effect of phagocytosis on the reduced soluble sulfhydryl content of human granulocytes

The role of reduced glutathione in relation to hexose monophosphate shunt activity and peroxide detoxification has been well established in human erythrocytes. Less is known about the content of reduced glutathione in phagocytic leukocytes and the changes that occur during functional activity. We have measured the reduced sulfhydryl content of normal resting human granulocytes and of cells isolated from a patient with chronic granulomatous disease. Normal cells and those from the patient with chronic granulomatous disease contained similar concentrations of reduced sulfhydryls. Stimulation of a phagocytic response by incubation with opsonized zymosan particles resulted in prompt and nearly complete depletion of intracellular glutathione from normal granulocytes. This fall in reduced glutathione concentration was dependent on the phagocytic load. Exposure of chronic granulomatous disease granulocytes to a similar phagocytic load resulted in a slower and less complete fall in reduced glutathione. In normal cells, those from the chronic granulomatous disease patient, and those from an obligate carrier of the disease, the decrement in reduced glutathione during phagocytosis was correlated with oxidation of 14C-1-glucose and 14C-formate, nitroblue tetrazolium reduction, and the chemiluminescence phenomenon.     

冠心病合并糖尿病患者可降解涂层雷帕霉素洗脱支架置入术后5年随访研究

目的探讨冠心病合并糖尿病患者经皮冠状动脉介入（PCI）置入EXCEL可降解涂层雷帕霉素洗脱支架（SES）治疗的远期疗效。方法回顾性随机入选2007年1月至2007年12月住院期间冠心病合并糖尿病患者行PCI162例,并入选同时期150例无糖尿病的冠心病患者行PCI为对照组。随访5年,随访包括心绞痛复发、死亡、心肌梗死、卒中和再次血运重建的主要不良心脑血管事件。结果两组支架术成功率均为100％。随访率100％,随访5年,糖尿病组与非糖尿病组术后并发症发生率（8．8％、7．0％）、卒中发生率（3．9％、3．0％）、心源性死亡率（0．0％、0．0％）差异无统计学意义（均为P〉0．05）。再次血运重建率（30．4％、14．0％）、心绞痛复发率（42,1％、30．0％）、全因死亡率（9．8％、2．0％）糖尿病组高于非糖尿病组;但心源性病死率均为0．0％。结论选择性冠脉内置入药物洗脱支架安全,成功率高,远期疗效尚好,但糖尿病仍是远期不良预后的独立预测因素。